David's lecture > Constipation > Flashcards

Constipation Flashcards

(55 cards)

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1
Q

What are some of the functions of the small intestine?

A
  • Reabsorbs water and compact material into feces
  • Absorbs vitamins produced by bacteria
  • Store fecal matter prior to defecation
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2
Q

List the areas of the colon and what each are involved in?

A
  • Ascending , Tranverse, descending - ivolved in the reabsorption of water and vitamins
  • Sigmoid, rectum, anal canal - Involved in packaging of the remaining material into feaces
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3
Q

The ransit of small labeled markers through the large intestine occurs in 36-48hrs. TRUE OR FALSE?

A

TRUE

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4
Q

What does haustrations and mass movement do and what do they aid in?

A
  • Haustrations (mixing movement) : aids in reabsorption and packaging
  • Mass movement (Propulsive movements) : Keeps material moving though the colon
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5
Q

List some of the Rome criteria for the diagnosis of constipation?

A
  • Two stools or less per week
  • A feeling of incomplete evacuation at least 25% of the time
  • A feeling of anal blockage
  • Straining at stool at least 25% of the time
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6
Q

What are the pathophysiological components of chronic constipation?

A
  • abnormal intrinsic motility
  • Lack of luminal factors
  • Medications (can cause abnormal motility)
  • Impaired defecation
  • Lack of extrinisic innervation in paraplegia
  • Hormones
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7
Q

What is latrogenic constipation?

A

-When symptoms are caused by medication

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8
Q

What type of medications cause constipation?

A

-Pain medications, iron, calcium, blood pressure medications

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9
Q

Opiods induced constipation in palliative care is common. TRUE OR FALSE?

A

TRUE

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10
Q

How do opiods cause constipation?

A
  • They increase smooth muscle tone which supresses forward peristalsis, increases tone in anal sphincters, Increases transit time and water absorption
  • They reduce sensitivity to anal distention which reduces urge to defecate
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11
Q

What is the most common cause of constipation?

A

-Through the misuse of laxatives

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12
Q

How do the misuse of laxatives cause constipation?

A
  • Longer interval needed to refill colon is misinterpreted as constipation which leads to further laxative use
  • Causes eneteral loss of water and salts leads to release of aldosterone which stimulates reabsorption in intestine, but increaseenal excretion of potassium ions
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13
Q

What does the dobule loss of potassiu ions from renal excretion lead to and what does this do the rate of peristalsis?

A

Hypokalemia which reduces peristalsis

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14
Q

What is the role of aldosterone?

A

Stimulates the kidneys to absorb and retain water

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15
Q

What is impaired defecation?

A

-The loss of feedback between components of the fecal reflex

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16
Q

Constipation is a disease. TRUE OR FALSE?

A

FALSE

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17
Q

List the therapy classes for constipation?

A
  1. Bulk forming laxatives
  2. Osmotic laxatives
  3. Stimulant laxatives
  4. Stool softeners
  5. Other agents
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18
Q

what is the mechanim of action for each of the therapy classes for constipation?

A
  1. Bulk forming laxatives : Fiber increases bulk of the stool which activates stretch receptors in the wall of the colon which acts to increase colonic activity
  2. Osmotic laxatives : Increases fluid content of stools which activates stretch receptors which increases fecal activity.
  3. Stimulant laxatives : They increase peristalsis by increasing the activity of muscles in the colon
  4. Stool softeners : These lubricates the stool and helps them pass through the colon easily
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19
Q

What are some of the general contraindication for use of laxatives?

A
  • Laxatives should not be used in the presence of undiagnosed abdominal pain
  • The drug may cause cause an inflamed organ to rupture and spill in GI
  • Oral drugs are also contranindicated when a diagnosed GI disturbance is likely to be worsened by increased motility
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20
Q

Bulk laxatives are insoluble, non digestible and non absorbable. TRUE OR FALSE?

A

TRUE

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21
Q

How long do bulk laxatives take to act?

A

-Takes several days (2 weeks)

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22
Q

List three bulk laxatives?

A
  • Isphagula
  • Methylcellulose
  • Sterculia
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23
Q

What are some fo the ADRs of bulk laxatives?

Study These Flashcards
A

-Bloating and flatulence, GI obstruction and impaction

24
Q

What are the cautions for taking bulk laxatives?

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A

-Adequate fluid intake should be maintained to avoid obstruction

25
What are the contranindications for bulk laxtaives?
- Colonic atony - colon will not be stimulated by actiavtion of stretch receptors - Faecal impaction and instestinal obstruction - increased motility will not lead to defecation
26
How long does it take for osmotic laxtaives to work and when is this used?
1-3 hours | Used prior to surgery or in poisoning
27
What are osmotic laxatives made up of?
- Non digestible sugars and alcohols - Macrogol (which is a polymer of ethylene glycol - Salts (Magnesium hydorxide (milk of magnesia), sodium phosphate
28
How does lactulose cause the omsotic effect?
-It is broken down by bacteria to acetic and lactic acid
29
What are the tow main issues associated with osmotic laxative?
- Increased GI activity | - Electrolyte and osmotic imbalances - danger may cause dehydration
30
What are the ADRs for osmotic laxatives?
-Abdominal discomfort and diarrhoea
31
What cautions need to be taken when using osmotic laxatives?
- Danger of dehydration (The elderly and debilitated) | - Those at risk of electrolyte imbalance - Cardiac diseases
32
What are the CIs for osmotic laxatives?
-Acute GI conditions , intestinal obstruction and inflammation
33
Stimulant laxative are indicated for severe constipation where more rapid effect is required (6-8hrs). TRUE OR FALSE?
TRUE
34
Name some of stimulant laxatives?
- BIsacodyl - Anthraquinones - senna - Castor oil, cascara
35
Bisacodyl and sodium picosulfate end with the same ingredient and Bisacodyl is activated by hydrolyzes found in the gut wall. TRUE OR FALSE?
TRUE
36
Senna and sodium picosulfate are activated by colonic flora. TRUE OR FALSE?
TRUE
37
What are the two main issues with Stimulant laxatives?
- Increased GI activity | - Electrolyte and osmotic imbalances
38
What are some of the cautions that have to be taken when prescibing stimulant laxatives?
-Those at risk of dehydration or hypokaleamia
39
What are the CIs for stimulant laxatives?
- Inflamed and obstructed intestines | - Undiagnosed abdominal pain
40
Co-danthrusate and co-danthramer show evidence of carcinogenicity and genotoxicity in animal studies. TRUE OR FALSE?
TRUE
41
Provide examples of stool softners?
- Docusate sodium - Arachis oil (enema) - Liquid paraffin (oral solution)
42
Docusate sodium is a surfactant and a bulking agent. TRUE OR FALSE?
TRUE
43
How long does docusate sodium take to work?
- 1-2 days
44
What are the ADRs and cautions for docusate sodium?
- Abdominal pain, diarrhoea, hypokaleamia | - Cautions : Patients where hypokalaemia to be avoided, rectal preparation not indicated with haemorrhoids
45
What are the CIs for docusate sodium?
-Intestinal blockage
46
Methylnatrexone is a peripherally acting opioid antagonist. TRUE OR FALSE?
TRUE
47
What is the half life and the maximum Tmax of Methylnatrexone?
- Half life 8hrs | - Tmax is 0.5 hrs
48
What are the ADRs and cautions for Methylnatrexone?
- Abdominal pain, diarrhoea, flactulence | - Cautions : Patients with damaged GI tract
49
What are the CIs for Methylnatrexone?
-Acute surgical abdominal conditions, intestinal blockage
50
Prucalopride is a selective 5HT-4 agonist with prokinetic properties. TRUE OR FALSE?
TRUE
51
What are the ADRs and cautions of Prucalopride?
- ADRs: Wide range of abdominal side effects associated with action - Cautions : Arrythmias and ischaemic heart disease (hERG)
52
What are the CIs for Prucalopride?
-Crohn's disease, abdominal obstruction and other serious GI conditions
53
What is Lubiprostone (Amitiza) and how does it work?
-A chloride channel blocker - acts locally to increase fluid secretion and motility
54
Lubiprostone (Amitiza) has low bioavailability. TRUE OR FALSE?
TRUE
55
What are the ADRs and the contraindications for Lubiprostone (Amitiza)?
- ADRs : Wide range of abdominal side effects associated with action - Contranindications - Gi obstruction
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